EndocrineThyrotoxicosis does not protect against incidental papillary thyroid cancer
Section snippets
Methods
After approval by the hospital research and ethics committee, a review of the thyroid database of the Monash University Endocrine Surgery Unit was performed. Data were obtained for the period September 1994 to August 2012. We identified those patients who underwent total thyroidectomy (n = 1,898), including patient demographics, thyroid status (thyrotoxic, euthyroid, or hypothyroid), and results of fine needle aspiration (FNA) cytology and histopathology. Thyrotoxicosis was defined by the
Results
Of the 1,508 patients included in the study, 96 (6.4%) had thyroid cancer. The mean age was 54.5 ± 15.6 years and the majority of patients were female (82.4%). The age of patients with Graves' disease was younger than patients with nontoxic and toxic MNG (39.8 ± 12.7 vs 56.7 ± 14.4 and 59.7 ± 14.1 years, respectively; P < .0001). There was a female predominance across all study groups, however, there were greater numbers of female patients in the Graves' group compared with the nontoxic MNG and
Discussion
Graves' disease, toxic MNG, and toxic adenomas are the most common causes of hyperthyroidism, and total thyroidectomy is the standard surgical treatment for patients with both bilateral benign MNG and Graves' disease.6, 10
Many studies have linked TSH and PTC. Boelaert et al7 reported that serum TSH is an independent predictor of malignancy in thyroid nodules and that the risk of malignancy rises in parallel with serum TSH, even for values in the normal range. Fiore et al8 conducted a study of
References (14)
- et al.
Increasing incidence of thyroid cancer is due to increased pathologic detection
Surgery
(2008) - et al.
Cancer after thyroidectomy: a multi-institutional experience with 1,523 patients
J Am Coll Surg
(2013) - et al.
Incidental thyroid carcinoma in patients with Graves' disease
Am J Surg
(2008) - Cancer (AIHW). Canberra: Australian Institute of Health and Welfare; 2013 [cited 19 May 2013] Available from...
- et al.
Should all papillary thyroid microcarcinomas be aggressively treated? An analysis of 18,445 cases
Ann Surg
(2011) - et al.
An update on papillary microcarcinoma
Curr Opin Oncol
(2009) - et al.
Papillary microcarcinoma of the thyroid gland
Br J Surg
(1997)
Cited by (16)
Toxic nodular goiter and thyroid cancer: Is hyperthyroidism protective against thyroid cancer?
2019, Surgery (United States)Citation Excerpt :The authors concluded there was no association between TSH and the incidence of papillary cancer. In another study, the rates of incidental thyroid cancer were 6.4% in Graves’, 6.8% in TMNG, and 5% in patients with multinodular goiter, suggesting that hyperthyroidism does not offer protection against papillary thyroid cancer in the extranodular thyroid tissue.22 In a frequently cited study by Fiore et al3, the prevalence of papillary thyroid cancer in patients with TSH <0.4 μU/mL was significantly less than in patients with no evidence of thyroid autonomy; this finding was interpreted because thyroid autonomy might play a protective role against the development of papillary thyroid cancer in the extranodular thyroid tissue.
Incidental versus non-incidental thyroid carcinoma: Clinical presentation, surgical management and prognosis
2016, Endocrinologia y NutricionOverdiagnosis of Thyroid Cancer. Answers to Five Key Questions.
2015, Academic RadiologyCitation Excerpt :Another activity leading to detection of thyroid cancers within the subclinical reservoir is analysis of the pathology specimen after thyroid surgery. Routine processing of surgical specimens for goiter and thyrotoxicosis finds incidental cancers in 6%–18% of patients (48,49). An increase in these surgical procedures could contribute to the increase in incidence of subclinical cancers.
Unilateral Graves’ Disease and Papillary Thyroid Carcinoma: Case Report and Review of Literature
2022, World Journal of Endocrine Surgery